Healthcare Provider Details

I. General information

NPI: 1952961237
Provider Name (Legal Business Name): CHRISTIAN DAVIS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 ELNORA DR
MACON GA
31210-1823
US

IV. Provider business mailing address

4020 ELNORA DR
MACON GA
31210-1823
US

V. Phone/Fax

Practice location:
  • Phone: 478-477-1228
  • Fax:
Mailing address:
  • Phone: 478-477-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN015866
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: